Background: Post-extubation patients often report dysphonia, sore throat, dysphagia and vocal fatigue, among others. The leading causes of these symptoms are damages either to the recurrent laryngeal nerve or to the vocal cords by the laryngoscope or the endotracheal tube. Although these symptoms are mostly transient and self-limiting, more severe injuries may persist and can be very challenging since they may lead to respiratory stress with need for reintubation, which increases patients morbidity and mortality. Glottic or subglottic stenosis are rare, late-onset laryngotracheal complications after prolonged endotracheal intubation and tracheotomy. The objective of this case report is to underline the importance of accurate and standardized follow-ups for post-extubation patients with high risk for laryngeal sequelae.

Methods: We present the case of a 26-year old woman with a history of recurrent episodes of inspiratory stridor, breathlessness and hoarseness over a few months following a prolonged, long-term intubation in the context of EBV-associated meningoencephalitis. Previously conducted otorhinolaryngologic assessment with flexible endoscopy, bronchoscopy and chest CT suggested normal findings of the airways. Following an inconclusive video-laryngoscopy conducted elsewhere, we identified a hidden, rigid synechia in the posterior third of the vocal cords.

Results: After the synechia was identified and transected, the patient recovered completely.

Discussion: Since post-extubation laryngeal injuries and dysfunctions are a frequent complication but often overlooked, we argue that the introduction of standardized clinical follow-ups and an early diagnosis in patients with a history of prolonged intubation are mandatory to prevent and manage laryngeal sequelae.

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